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Testosterone therapy
Testosterone therapy is a form of hormone therapy in which testosterone is administered to supplement existing low level of the hormone Routes of administration There are many routes of administration for testosterone. Forms of testosterone for human administration currently available include injectable (such as testosterone cypionate or testosterone enanthate in oil), oral, buccal, transdermal skin patches, and transdermal creams or gels. and In the pipeline are "roll on" methods and nasal sprays. Indications The original and primary use of testosterone is for the treatment of males who have too little or no natural endogenous testosterone production—males with hypogonadism. Appropriate use for this purpose is legitimate hormone replacement therapy (testosterone replacement therapy TRT), which maintains serum testosterone levels in the normal range. However, over the years, as with every hormone, testosterone or other anabolic steroids has also been given for many other conditions and purposes besides replacement, with variable success but higher rates of side effects or problems. Examples include infertility, lack of libido or erectile dysfunction, osteoporosis, penile enlargement, height growth, bone marrow stimulation and reversal of anemia, and even appetite stimulation. By the late 1940s testosterone was being touted as an anti-aging wonder drug (e.g., see Paul de Kruif's The Male Hormone). Decline of testosterone production with age has led to interest in androgen replacement therapy. To take advantage of its virilizing effects, testosterone is often administered to transsexual men as part of the hormone replacement therapy, with a "target level" of the normal male testosterone level. Like-wise, transsexual men are sometimes prescribed anti-androgens to decrease the level of testosterone in the body and allow for the effects of estrogen to develop. Testosterone patches are effective at treating low libido in post-menopausal women. Low libido may also occur as a symptom or outcome of hormonal contraceptive use. Women may also use testosterone therapies to treat or prevent loss of bone density, muscle mass and to treat certain kinds of depression and low energy state. Women on testosterone therapies may experience an increase in weight without an increase in body fat due to changes in bone and muscle density. Most undesired effects of testosterone therapy in women may be controlled by hair-reduction strategies, acne prevention, etc. There is a theoretical risk that testosterone therapy may increase the risk of breast or gynaecological cancers, and further research is needed to define any such risks more clearly. Hormone replacement therapy Testosterone levels decline gradually with age in human beings. The clinical significance of this decrease is debated (see andropause). There is disagreement about when to treat aging men with testosterone replacement therapy. The American Society of Andrology's position is that: The American Association of Clinical Endocrinologists says: There is not total agreement on the threshold of testosterone value below which a man would be considered hypogonadal. (Currently there are no standards as to when to treat women.) Testosterone can be measured as "free" (that is, bioavailable and unbound) or more commonly, "total" (including the percentage which is chemically bound and unavailable). In the United States, male total testosterone levels below 300 ng/dL from a morning serum sample are generally considered low. However these numbers are typically not age-adjusted, but based on an average of a test group which includes elderly males with low testosterone levels. Therefore a value of 300 ng/dL might be normal for a 65-year-old male, but not normal for a 30-year-old. Identification of inadequate testosterone in an aging male by symptoms alone can be difficult. The signs and symptoms are non-specific, and might be confused with normal aging characteristics, such as loss of muscle mass and bone density, decreased physical endurance, decreased memory ability , and loss of libido. Replacement therapy can take the form of injectable depots, transdermal patches and gels, subcutaneous pellets, and oral therapy. Adverse effects of testosterone supplementation include minor side effects such as acne and oily skin, and more significant complications such as increased hematocrit which can require venipuncture in order to treat, exacerbation of sleep apnea and acceleration of pre-existing prostate cancer growth in individuals who have undergone androgen deprivation. Exogenous testosterone also causes suppression of spermatogenesis and can lead to infertility. It is recommended that physicians screen for prostate cancer with a digital rectal exam and PSA (prostate specific antigen) level before starting therapy, and monitor hematocrit and PSA levels closely during therapy. Benefits Appropriate testosterone therapy can prevent or reduce the likelihood of osteoporosis, type 2 diabetes, cardio-vascular disease (CVD), obesity, depression and anxiety and the statistical risk of early mortality. Low testosterone also brings with it an increased risk for the development of Alzheimer’s Disease. A small trial in 2005 showed mixed results. Large scale trials to assess the efficiency and long-term safety of testosterone are still lacking. Adverse effects Exogenous testosterone supplementation comes with a number of health risks. Fluoxymesterone and methyltestosterone are synthetic derivatives of testosterone. In 2006 it was reported that women taking Estratest, a combination pill including estrogen and methyltestosterone, were at considerably heightened risk of breast cancer. That said, methyltestosterone and Fluoxymesterone are no longer prescribed by physicians given their poor safety record, and testosterone replacement in men does have a very good safety record as evidenced by over sixty years of medical use in hypogonadal men. One adverse effect that many men complain of is that of the development of gynecomastia (breasts), but this is something that can be prevented by appropriate choice and dosing of medication, and, in required cases, the use of ancillary medications that help lower SHBG or estradiol. Another side-effect is having difficulty urinating. Athletic use Testosterone may be administered to an athlete in order to improve performance, and is considered to be a form of doping in most sports. There are several application methods for testosterone, including intramuscular injections, transdermal gels and patches, and implantable pellets. Anabolic steroids (including testosterone) have also been taken to enhance muscle development, strength, or endurance. They do so directly by increasing the muscles' protein synthesis. As a result, muscle fibers become larger and repair faster than the average person's. After a series of scandals and publicity in the 1980s (such as Ben Johnson's improved performance at the 1988 Summer Olympics), prohibitions of anabolic steroid use were renewed or strengthened by many sports organizations. Testosterone and other anabolic steroids were designated a "controlled substance" by the United States Congress in 1990, with the Anabolic Steroid Control Act. The levels of testosterone abused in sport greatly exceed the quantities of the steroid that are prescribed for medical use in hypogonadism. It is the supraphysiological doses and ultra high levels of testosterone that bring with it many undesirable effects and potential long term adverse health effects. Coupled with the nature of cheating in sport, this is seen as being a seriously problematic issue in modern sport, particularly given the lengths to which athletes and professional laboratories go to in trying to conceal such abuse from sports regulators. Steroid abuse once again came into the spotlight recently as a result of the Chris Benoit double murder-suicide in 2007, and the media frenzy surrounding it - however, there has been no evidence indicating steroid use as a contributing factor. References Further reading *Andrew, R. J., & Jones, R. (1992). Increased distractibility in capons: An adult parallel to androgen-induced effects in the domestic chick. Behavioural Processes, 26(2-3), 201-209. *Bain, J., Brock, G., & Kuzmarov, I. (2007). Canadian Society for the Study of the Aging Male: Response to health Canada's position paper on testosterone treatment. Journal of Sexual Medicine, 4(3), 558-566. *Basson, R. (2007). Hormones and sexuality: Current complexities and future directions. Maturitas, 57(1), 66-70. *Burris, A. S., Gracely, R. H., Carter, C., Sherins, R. J., & et al. (1991). Testosterone therapy is associated with reduced tactile sensitivity in males. Hormones and Behavior, 25(2), 195-205. *Buvat, J. (2006). It is time for a large trial of testosterone therapy for older men. Journal of Men's Health & Gender, 3(2), 169-171. *Carlson, N., Brenner, L., Wierman, M., Harrison-Felix, C., Morey, C., Gallagher, S., et al. (2009). Hypogonadism on admission to acute rehabilitation is correlated with lower functional status at admission and discharge. Brain Injury, 23(4), 336-344. *Chaudhry, M. (2003). A 60-year-old man with progressive malaise, fatigue and decreased libido. Canadian Medical Association Journal, 169(5), 445. *Cherry, J. A., & Lepri, J. J. (1986). Sexual dimorphism and gonadal control of ultrasonic vocalizations in adult pine voles, Microtus pinetorum. Hormones and Behavior, 20(1), 34-48. *Crenshaw, T. L. (1985). Transsexual problem. Medical Aspects of Human Sexuality, 19(12), 53-56. *Daly, R. C., Schmidt, P. J., Roca, C. A., & Rubinow, D. R. (2001). Testosterone's effects not limited to mood. Archives of General Psychiatry, 58(4), 403. *Davis, S. (2000). Testosterone and sexual desire in women. Journal of Sex Education & Therapy, 25(1), 25-32. *Davis, S. R., Wolfe, R., Farrugia, H., Ferdinand, A., & Bell, R. J. (2009). The incidence of invasive breast cancer among women prescribed testosterone for low libido. Journal of Sexual Medicine, 6(7), 1850-1856. *Davis, S. R., Wolfe, R., Farrugia, H., Ferdinand, A., & Bell, R. J. (2010). "Testosterone and breast cancer": Author response. Journal of Sexual Medicine, 7(2, Pt 2), 1036-1037. *Emmelot-Vonk, M. H., Verhaar, H. J., & van der Schouw, Y. T. (2008). Effects of testosterone therapy in older men: Reply. JAMA: Journal of the American Medical Association, 299(16), 1900-1901. *Freeman, M. P., & Freeman, S. A. (2003). Treatment of leuprolide-induced depression with intramuscular testosterone: A case report. Journal of Clinical Psychiatry, 64(3), 341-343. *Goldman, S. (2005). Review of The Pursuit of Perfection: The Promise and Perils of Medical Enhancement. Psychiatric Services, 56(8), 1027-1028. *Goldstein, S. W. (2009). My turn... finally. Journal of Sexual Medicine, 6(2), 301-302. *Guay, A. T., Smith, T. M., & Offutt, L. A. (2009). Absorption of testosterone gel 1% (Testim) from three different application sites. Journal of Sexual Medicine, 6(9), 2601-2610. *Hall, S. A., Araujo, A. B., Kupelian, V., Maserejian, N. N., & Travison, T. G. (2010). Testosterone and breast cancer. Journal of Sexual Medicine, 7(2, Pt 2), 1035-1036. *Isaac, G. (1978). Steroid hormones in schizophrenia. Schizophrenia Bulletin, 4(1), 19. *Kaufman, S. L. (1985). Micropenis. Medical Aspects of Human Sexuality, 19(3), 83-91. *Kingsberg, S. (2007). Testosterone treatment for hypoactive sexual desire disorder in postmenopausal women. Journal of Sexual Medicine, 4(Suppl3), 227-234. *Kotz, K., Alexander, J. L., & Dennerstein, L. (2006). Estrogen and Androgen Hormone Therapy and Well-Being in Surgically Postmenopausal Women. Journal of Women's Health, 15(8), 898-908. *Krapf, J. M., & Simon, J. A. (2009). The role of testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. Maturitas, 63(3), 213-219. *Lu, P. H., Masterman, D. A., Mulnard, R., Cotman, C., Miller, B., Yaffe, K., et al. (2006). Effects of Testosterone on Cognition and Mood in Male Patients With Mild Alzheimer Disease and Healthy Elderly Men. Archives of Neurology, 63(2), 177-185. *Matza, A. R. (2009). The Boston "t" party: Masculinity, testosterone therapy, and embodiment among aging men and transgender men. Dissertation Abstracts International Section A: Humanities and Social Sciences, 70(5-A), 1696. *Meyer, W. J., Walker, P. A., & Suplee, Z. R. (1981). A survey of transsexual hormonal treatment in twenty gender-treatment centers. Journal of Sex Research, 17(4), 344-349. *Miller, K. K., Deckersbach, T., Rauch, S. L., Fischman, A. J., Grieco, K. A., Herzog, D. B., et al. (2004). Testosterone administration attenuates regional brain hypometabolism in women with anorexia nervosa. Psychiatry Research: Neuroimaging, 132(3), 197-207. *Morelli, A., Fibbi, B., Marini, M., Silvestrini, E., De Vita, G., Chavalmane, A. K., et al. (2009). Dihydrotestosterone and leptin regulate gonadotropin-releasing hormone (GnRH) expression and secretion in human GnRH-secreting neuroblasts. Journal of Sexual Medicine, 6(2), 397-407. *Morgentaler, A. (2008). Guilt by association: A historical perspective on Huggins, testosterone therapy, and prostate cancer. Journal of Sexual Medicine, 5(8), 1834-1840. *Morgentaler, A. (2009). Two years of testosterone therapy associated with decline in prostate-specific antigen in a man with untreated prostate cancer. Journal of Sexual Medicine, 6(2), 574-577. *O'Carroll, R. E., & Bancroft, J. (1984). Testosterone therapy for low sexual interest and erectile dysfunction in men: A controlled study. British Journal of Psychiatry, 145, 146-151. *Okun, M. S., Fernandez, H. H., Rodriguez, R. L., Romrell, J., Suelter, M., Munson, S., et al. (2006). Testosterone Therapy in Men With Parkinson Disease: Results of the TEST-PD Study. Archives of Neurology, 63(5), 729-735. *Page, S., & Matsumoto, A. M. (2008). Effects of testosterone therapy in older men: Comment. JAMA: Journal of the American Medical Association, 299(16), 1900. *Panzer, C., & Guay, A. (2009). Testosterone replacement therapy in naturally and surgically menopausal women. Journal of Sexual Medicine, 6(1), 8-18. *Pennebaker, J. W., Groom, C. J., Loew, D., & Dabbs, J. M. (2004). Testosterone as a Social Inhibitor: Two Case Studies of the Effect of Testosterone Treatment on Language. Journal of Abnormal Psychology, 113(1), 172-175. *Perry, P. J., Yates, W. R., Williams, R. D., Andersen, A. E., MacIndoe, J. H., Lund, B. C., et al. (2002). Testosterone therapy in late-life major depression in males. Journal of Clinical Psychiatry, 63(12), 1096-1101. *Phoenix, C. H., & Chambers, K. C. (1988). Testosterone therapy in young and old rhesus males that display low levels of sexual activity. Physiology & Behavior, 43(4), 479-484. *Pope, H. G., Jr., Amiaz, R., Brennan, B. P., Orr, G., Weiser, M., Kelly, J. E., et al. (2010). Parallel-group placebo-controlled trial of testosterone gel in men with major depressive disorder displaying an incomplete response to standard antidepressant treatment. Journal of Clinical Psychopharmacology, 30(2), 126-134. *Rabkin, J. G., Rabkin, R., & Wagner, G. J. (2001). Reply. Archives of General Psychiatry, 58(4), 403-404. *Rabkin, J. G., Wagner, G. J., & Rabkin, R. (1999). Testosterone therapy for human immunodeficiency virus: Positive men with and without hypogonadism. Journal of Clinical Psychopharmacology, 19(1), 19-27. *Rabkin, J. G., Wagner, G. J., & Rabkin, R. (2000). A double-blind, placebo-controlled trial of testosterone therapy for HIV-positive men with hypogonadal symptoms. Archives of General Psychiatry, 57(2), 141-147. *Rhoden, E. L., & Morgentaler, A. (2010). Symptomatic response rates to testosterone therapy and the likelihood of completing 12 months of therapy in clinical practice. Journal of Sexual Medicine, 7(1, Pt 1), 277-283. *Rice, D., Brannigan, R. E., Sr., Campbell, R., Fine, S., Jack, L., Jr., Nelson, J. B., et al. (2008). Men's health, low testosterone, and diabetes: Individualized treatment and a multidisciplinary approach. The Diabetes Educator, 34(5,Suppl), 96S-114S. *Richard-Yris, M., & Leboucher, G. (1987). Induction and maintenance of maternal behaviour in the domestic hen: Influence of testosterone and oestradiol treatments. Ethology formerly Zeitschrift fur Tierpsychologie, 75(4), 337-347. *Schweizer, K., Brinkmann, L., & Richter-Appelt, H. (2007). On the problem of male gender assignment in the case of XX chromosome persons with adrenogenital syndrome (AGS). Zeitschrift fur Sexualforschung, 20(2), 145-161. *Seftel, A. D. (2005). From Aspiration to Achievement: Assessment and Noninvasive Treatment of Erectile Dysfunction in Aging Men. Journal of the American Geriatrics Society, 53(1), 119-130. *Segraves, R., & Woodard, T. (2006). Female Hypoactive Sexual Desire Disorder: History and Current Status. Journal of Sexual Medicine, 3(3), 408-418. *Segraves, R. T. (2007). Female sexual dysfunction. Primary Psychiatry, 14(2), 37-41. *Seidman, S. N., Miyazaki, M., & Roose, S. P. (2005). Intramuscular testosterone supplementation to selective serotonin reuptake inhibitor in treatment-resistant depressed men: Randomized placebo-controlled clinical trial. Journal of Clinical Psychopharmacology, 25(6), 584-588. *Shabsigh, A., Kang, Y., Shabsign, R., Gonzalez, M., Liberson, G., Fisch, H., et al. (2005). Clomiphene Citrate Eiffects on Testosterone/Estrogen Ratio in Male Hypogonadism. Journal of Sexual Medicine, 2(5), 716-721. *Shabsigh, R. (2005). Testosterone Therapy in Erectile Dysfunction and Hypogonadism. Journal of Sexual Medicine, 2(6), 785-792. *Shah, K., & Montoya, C. (2007). Do testosterone injections increase libido for elderly hypogonadal patients? The Journal of Family Practice, 56(4), 301-303. *Shifren, J. L., Braunstein, G. D., Simon, J. A., Casson, P. R., Buster, J. E., Redmond, G. P., et al. (2000). Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. The New England Journal of Medicine, 343(10), 682-688. *Sila, C. (2009). Stroke. CONTINUUM: Lifelong Learning in Neurology, 15(2), 81-90. *Simpkins, J. W., & Van Meter, R. (2005). Potential Testosterone Therapy for Hypogonadal Sexual Dysfunction in Women. Journal of Women's Health, 14(5), 449-451. *Stuckey, B. G. (2008). Female sexual function and dysfunction in the reproductive years: The influence of endogenous and exogenous sex hormones. Journal of Sexual Medicine, 5(10), 2282-2290. *Tan, R. S., & Culberson, J. W. (2003). An integrative review on current evidence of testosterone replacement therapy for the andropause. Maturitas, 45(1), 15-27. *Traish, A. M., Feeley, R. J., & Guay, A. T. (2009). Testosterone therapy in women with gynecological and sexual disorders: A triumph of clinical endocrinology from 1938 to 2008. Journal of Sexual Medicine, 6(2), 334-351. *Van Oortmerssen, G., Dijk, D., & Schuurman, T. (1987). Studies in wild house mice: II. Testosterone and aggression. Hormones and Behavior, 21(2), 139-152. *Wagner, G., Rabkin, J., & Rabkin, R. (1997). Response to commentaries. Journal of Sex Research, 34(1), 37-38. *Wagner, G., Rabkin, J., & Rabkin, R. (1998). Exercise as a mediator of psychological and nutritional effects of testosterone therapy in HIV+ men. Medicine & Science in Sports & Exercise, 30(6), 811-817. *Wagner, G. J., & Rabkin, J. (1998). Testosterone therapy for clinical symptoms of hypogonadism in eugonadal men with AIDS. International Journal of STD & AIDS, 9(1), 41-44. *Wagner, G. J., Rabkin, J. G., & Rabkin, R. (1998). Testosterone as a treatment for fatigue in HIV+ men. General Hospital Psychiatry, 20(4), 209-213. *Wylie, K., & Davies-South, D. (2004). A study of treatment choices in men with erectile dysfunction and reduced androgen levels. Journal of Sex & Marital Therapy, 30(2), 107-144. *Yates, W. R., Perry, P. J., MacIndoe, J., Holman, T., & Ellingrod, V. (1999). Psychosexual effects of three doses of testosterone cycling in normal men. Biological Psychiatry, 45(3), 254-260. Category:Hormone therapy Category:Testosterone Category:Testosterone therapy